Primary parathyroid

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Overview

The parathyroid is comprised of 4 small glands embedded in the posterior aspect of the thyroid gland. Its main function is the production and secretion of parathyroid hormone (PTH), a polypeptide hormone responsible for maintaining serum calcium homeostasis. The levels of PTH and serum calcium are inversely proportional. At low serum calcium levels, PTH, in conjunction with vitamin D, works at many sites in the body to mobilize calcium stores and increase calcium absorption and reabsorption. Both calcium and vitamin D provide negative feedback to the parathyroid glands; as levels of calcium and vitamin D increase, they bind receptors at the parathyroid glands and inhibit the production and release of PTH.

Symptoms

If you have early hyperparathyroidism, you may not have any symptoms. If you have mild hyperparathyroidism, you may have some of the following symptoms:

Joint pain.

Muscle weakness.

Feeling tired.

Depression.

Trouble concentrating.

Loss of appetite.

If your hyperparathyroidism is more severe, you may have these symptoms:

Nausea and vomiting.

Confusion, forgetfulness.

Increased thirst and need to urinate.

Constipation.

Bone pain.

Other problems associated with severe hyperparathyroidism include:

Reduced kidney function, which affects your kidney’s ability to filter blood.

Kidney stones.

Thinning bones (osteoporosis).

High blood pressure. High blood calcium levels may play a role in the development of high blood pressure.

Causes

Primary hyperparathyroidism occurs when your parathyroid glands produce too much PTH. A variety of conditions can result in hyperparathyroidism, such as the following.


Adenoma

An adenoma is a noncancerous tumor on one of these glands. These tumors are the most common cause of primary hyperparathyroidism.

Parathyroid gland enlargement

In other cases, enlargement of at least two of your parathyroid glands can lead to hyperparathyroidism. Doctors often don’t know what causes this enlargement.

Parathyroid cancer

In rare cases, parathyroid cancer may cause enlargement of one or more of the parathyroid glands. These tumors can cause hyperparathyroidism.

Risk factors

Are a woman who has gone through menopause.

Have had prolonged, severe calcium or vitamin D deficiency.

Have a rare, inherited disorder, such as multiple endocrine neoplasia, type 1, which usually affects multiple glands.

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Complications

Complications of hyperparathyroidism are mainly related to the long-term effect of too little calcium in your bones and too much calcium in your bloodstream. Common complications include:

Osteoporosis. The loss of calcium from bones often results in weak, brittle bones that break easily (osteoporosis).

Kidney stones. Too much calcium in your blood may lead to too much calcium in your urine. This can cause small, hard deposits of calcium and other substances to form in your kidneys (kidney stone). A kidney stone usually causes major pain as it passes from the kidneys through the urinary tract.

Cardiovascular disease. Although the exact cause-and-effect link is unclear, high calcium levels are associated with heart and blood vessel (cardiovascular) conditions, such as high blood pressure and certain types of heart disease.

Neonatal hypoparathyroidism. Severe, untreated hyperparathyroidism in pregnant women may cause dangerously low levels of calcium in newborns. Primary hyperparathyroidism is not common in women of childbearing age.

Prevention

If you and your health care provider have chosen to monitor, rather than treat, your primary hyperparathyroidism, the following suggestions can help prevent complications: